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Member Practice Update

10 April 2019

Welcome to the Member Practice Update

This weekly Member Practice Update is produced by NHS Redditch and Bromsgrove, NHS South Worcestershire and NHS Wyre Forest Clinical Commissioning Groups for circulation in your practice, to provide you with essential guidance, information and useful support.

Your views and feedback are very much appreciated. If you have any comments, suggestions or contributions for inclusion in the Member Practice Bulletin, please e-mail the communications team.

In this issue:

  1. PRIMARY CARE NETWORKS - Initial PCN Network Agreement – Submission Process
  2. GP Contract Reform: Primary Care Networks
  3. Q1 PCE Payments
  4. Minimising the Impact of Radiological Discrepancies
  5. Review of invalid opt out Read codes – ACTION REQUIRED
  6. In Alliance Newsletter - April 2019
  7. Prescribing Top Tip
  8. REMINDER: NHS Health Checks 5 year Audit Report
  9. REMINDER: New Lifestyle Offer
  10. Domestic Abuse Training
  11. WSCB Survey & Annual Report
  12. The Victim Advice Line (VAL) is going live on 1st April 2019
  13. Save the Date – Dementia Education Event

Find out about local and national events and training here.

  • No Redditch & Bromsgrove news 
  • No specific South Worcestershire news
  • No specific Wyre Forest news 

PRIMARY CARE NETWORKS - Initial PCN Network Agreement – Submission Process  

The Primary Care Network DES will commence on 1 July 2019 and remain in place, evolving annually, until at least 31 March 2024. The first year of this DES is a development year with the majority of service requirements being introduced from April 2020 onwards. The success of a PCN will depend on the strengths of its relationships, and in particular the bonds of affiliations between its members and the wider health and social care community who care for the population. Non-gp providers are essential in supporting delivery.

"Investment and Evolution: A five-year framework for GP contract reform to implement the NHS Long Term Plan" and the Network Contract Directed Enhanced Service require PCNs to submit an initial Network Agreement to the CCG by 15 May 2019 and that the CCG confirm that the registration requirements have been met by no later than Friday 31 May 2019 . 

Could you please send this to us by Friday, 10 May. This will provide time for the Primary Care Commissioning Team to review, identify any gaps either in information or population and geographic coverage and make sure that all PCNs meet the registration requirements.  

The Registration Forms will be considered by a Panel whose membership will be made up from both Hereford & Worcester LMC, Governing Body GPs and the CCG. The Panel is expected to meet on 16 May with final confirmation taking place at the Primary Care Commissioning Committees ‘meeting in common’ on 22 May 2019.

A word version of the Registration Form is available here, Please also complete page 3 of the Mandatory Network Agreement as well as schedule 1 and return to the Primary Care generic email account: sowoccg.worcestershireprimarycare@nhs.net by 10 May. Let us know if you have any concerns or want any help.

The CCG has an important role to play with others in supporting PCNS. We have realigned a number of staff as points of contact. Please do not hesitate to contact your   Primary Care or Neighbourhood Team lead for support either directly or via the Primary Care generic email account shown below.  

A lot of questions have been asked at these meetings regarding roles and responsibilities of the Clinical Director, existing structures and how these may change reflecting the creation of PCNs. There’s a lot of work to be done nationally and locally to ensure that PCNS flourish and we recognise that this needs to be articulated over the next few months and shared with all practices. 

Further Network Agreements need to be completed and returned by 30 June. Please let us know if you need any support with this task. 

GP Contract Reform: Primary Care Networks 

A document compiling various Frequently Asked Questions around Primary Care Networks has been released by NHSE.

Acess it here.

Q1 PCE Payments  

Finance will be processing the 2019/20 Q1 PCE payments  in the week commencing 15 April. Payments will be based on:

  • One quarter of the £11, per weighted patient as at 1 January 2019 with an adjustment in RB for Woodrow patients re-registering between 1/1/19 and 31/3/19
  • The £2.75  (one quarter of the £11) will be adjusted for one quarter of the clinical leadership costs, appendix B.
  • One quarter of the annual  clinical leadership plan will be paid directly to those practices where the leaders are based.
  • An initial reduction of 30p per weighted patient based on the list at 1 January 2018, where practices missed the 2018/19 AF or Hypertension QOF+ targets. We will be agree an actual rate with the LMC, to then be ratified by the Primary Care Commissioning Committee. Any change to these rates will be reflected in future payments.

If you have any queries concerning this please do not hesitate to contact carolinesalmon@nhs.net

Minimising the Impact of Radiological Discrepancies 

It is an accepted fact that discrepancies occur in radiology reporting, due to various factors, despite our best efforts. Published data in the literature and guidance from the RCR indicates that radiological reporting discrepancy rates vary from 3-30%. Many of these discrepancies will have no clinical impact, but some unfortunately do. In the context of the very large volume of imaging we perform, this means that significant findings could be missed for your patients.

Within radiology we endeavour to pro-actively review, feedback, discuss, share and investigate when necessary, the discrepancies in reporting that we discover. This helps to minimise the risk of repeating similar errors, but we will never take the risk away altogether.

Therefore we rely on opportunities to spot discrepancies before they have an impact on patients. This can happen in formal review situations, such as at MDT meetings, but also informal image review and clinical discussion can be vital.

If you have concerns that an imaging report does not fit with the clinical picture for your patient, or there are persistent, progressive or concerning clinical features not explained by the current imaging, please don’t stop there. An imaging report should not over-rule clinical findings or suspicions and is only one component of an overall clinical assessment. 

We are available for discussion of these difficult cases. Sometimes review of the imaging may provide the answer or repeat or alternative investigation may be required.

The duty radiologist for the county is available for advice via switchboard at Worcestershire Royal Hospital on 01905-763333, extension 39165, 9am to 9pm, 7 days a week. Working together we can minimise the impact of these discrepancies on our patients.

Review of invalid opt out Read codes – ACTION REQUIRED 

Letter from NHS Digital dated March 2019

Following on from an email sent to all Practice Managers on the 3rd April relating to invalid opt out Read codes for patients that do not want to share information for research and planning purposes, please can we remind practices to run this EMIS search to check if invalid Read codes (9nu4 & 9Nu5) have been used since the 11th October 2018.

The following link will provide details on how to manage this process and the steps to take if type 2 codes have been recorded in error:

In Alliance Newsletter - April 2019 

The latest issue of the In Alliance Newsletter is now available.

Access it here.

Prescribing Top Tip 

Use of Carbocisteine in COPD

Carbocisteine is used as a mucolytic in the treatment of COPD to facilitate expectoration. The drug may be suitable for initiation where patients have a chronic productive cough and thick sputum; frequently it is started during an acute exacerbation.

The current NHS list prices (as per Drug Tariff April 19) of formulary carbocisteine presentations are listed in the table below:


NHS List Price

Carbocisteine Capsules 375mg (120)


Carbocisteine 250mg/5ml oral solution (300ml)


Note that carbocisteine must be prescribed generically and not as the less affordable Mucodyne® brand (£18.98 for 120 capsules, as per Mims, April 19)

The initial treatment dose of carbocisteine is 750mg three times daily for 4 weeks. Patients must be reviewed after this trial period, and if no benefit has been received, treatment should be stopped. If treatment has been beneficial, and symptoms are improving, the drug can be continued at a reduced maintenance dose of 750mg twice a day.

All patients receiving long-term courses of carbocisteine should therefore have been reviewed prior to commencement of ongoing maintenance therapy, and the higher treatment dose should not be routinely prescribed for these patients.

Note also that whilst mucolytics can be useful for symptom control, there is no evidence that these drugs prevent exacerbations.

Based on prescribing for the 12 months to the end of Jan 2019, the table below lists the current annual spend for all presentations of carbocisteine throughout the Worcestershire CCGs:



Redditch & Bromsgrove


South Worcestershire


Wyre Forest




If you have any suggestions for inclusion in the 'Top Tips' then please send them to akingham@nhs.net

REMINDER: NHS Health Checks 5 year Audit Report 

First of all, thank you for your ongoing support with the delivery of the NHS Health Checks service. Since 2014/15 more than 47% of eligible Worcestershire patients have attended an NHS Health Check, which is significantly higher than the national average of 40.9%. This means that more than 80,000 patients have accessed an NHS Health Check in Worcestershire during this time, received information about their health and wellbeing and had the opportunity to make improvements to their lifestyle.  

It is important that we have a clear understanding of the population that are accessing NHS Health Checks, their demographics and the ongoing impact of interventions to improve their health and wellbeing. To enable this and as part of a wider review of NHS Health Checks we are asking each GP Practice to run an EMIS report which will provide data from the last 5 years of delivery. This will help us to identify where the service has been particularly successful and any potential areas for further development.

Report Information is available here
. Could you please return the completed dataset in a spreadsheet to aboote@worcestershire.gov.uk before 18 April 2019.

Download the Audit Report.

Please note this EMIS search does not replace your standard quarterly returns which should be submitted as usual.

REMINDER: New Lifestyle Offer 

The current Living Well service contract (delivered by the Independence Trust) is ending on 31st March 2019. Over the years Worcestershire's lifestyle services have often struggled to engage fully with Primary Care to receive the number of referrals required to support those most in need.

Moving forward Public Health wish to work with the CCG to create a lifestyle offer that is more embedded within Primary Care as part of a wider integrated wellbeing offer. Public Health recently carried out some consultation through the neighbourhood team meetings to gain views on the current service and how a new model could be developed that is better at meeting the needs of those working in Primary Care and their patients.

For effective lifestyle services, PHE suggest the emphasis should be on the need to address the whole of the social determinants pathway in which psychosocial pathways are situated, supporting the need for more of an integrated wellness service which works closely with a social prescribing offer. In line with recent LTP developments, it is hoped that the lifestyle service will work alongside social prescribing and have a presence within each Primary Care Network.

Public Health and the CCG will be holding a workshop in May to support the development and implementation of a new lifestyle offer within Primary Care. We hope to gain views of GP's and practice managers about the most effective methods of integrating with the Primary Care Networks. If you are interested in being part of this discussion and would like to be notified of the workshop date, please contact  steven.connelly1@nhs.net.

Domestic Abuse Training  

The domestic abuse training commissioned across Worcestershire is going really well with each session sold out and the training dates projected until the end of July. Thank you to the agencies that have made their training rooms available to date. We looking to ensure that the training venues are across Worcestershire to allow accessibility to all. In order to have greater flexibility, we are looking for additional premises/rooms that could accommodate up to 25 delegates. Is there any agency that may be able to support this in addition to those already contributing?

If you can, please can you contact the following persons; Carole Thatcher and Claire Mitchell.

Thank you for your continued support.

WSCB Survey & Annual Report 

Worcestershire Safeguarding Children Board (WSCB) oversees the effectiveness of Early Help. To support this WSCB are keen to capture the voice of practitioners from a wide range of agencies who are involved in delivering Early Help (Level 2 and Level 3). The survey is intended for the wider workforce and includes all those who offer support to children and young people.

Please can you forward this email to any colleague who is involved in Early Help and ask them to complete the survey by 11th April, 2019. Your views do matter and the results of this survey will be presented to the Monitoring Effectiveness Group and included in the WSCB Annual Report. 

The survey should take less than five minutes to complete.

The survey can be accessed here

WSCB are also in the process of writing their Annual Report and seeking information on the following areas:

  1. Assurance that Learning and Improvement 11 has been disseminated

  2. MACFA 30 made a recommendation that all agencies should give serious consideration to setting up internal systems to quality assure their organisation's referrals to Children's Social Care (CSC). Please can you provide the assurance that you have, or are planning to review, systems for recording and monitoring the quality of referrals to CSC including identifying actions for learning and improvement as required (action from Board meeting 5th December, 2018). CSC have also provided a document which explains how to download and save a referral to CSC.

  3. Details of any single agency inspections that have taken place from April 2018 – March 2019 and a web link to the report pertaining to this.

See pro-forma for more information.

Please respond by 15th April, 2019.

If you have any questions in relation to this request please contact Angela Eason.

The Victim Advice Line (VAL) is going live on 1st April 2019 

The Victim Advice Line (VAL) is a free and confidential service that is available to anyone who has been impacted by crime. The VAL is made up of a team of professional, dedicated victim care coordinators whose roles are to assess victim needs and agree a tailored support plan specific to that individual. Please see the VAL video.

People can refer themselves, be referred by the police or by a third party. The VAL team will offer and provide a range of support to cope with the impact of the crime, including:

  • Undertaking a detailed needs assessment and agreeing a victim care plan;
  • Helping victims with the immediate emotional impact of the crime and how this has affected them and helping address their feelings of safety;
  • Access to explore Restorative Justice, which involves the victim communicating with the offender to explain the impact their actions have had;
  • Advocacy and support to help victims deal with practical issues resulting from the crime;
  • Providing timely and accurate information about the criminal justice process, what to expect, and their entitlements under the Victims’ Code;
  • Acting as the victim’s single point of contact, coordinating and facilitating their care plan, and managing any issues or queries.

VAL will work closely with specialist services to ensure that the victim or survivor gets the support they need when they need it, particularly for the most harmed and vulnerable victims. Support will be available to a victim whether they chose to report a crime or not to the police.

The victim also has the option to phone, email or use the online web chat service.

DD (not for public) – 01905 331415
Email: VictimAdviceLine@westmercia.pnn.police.uk

Freephone - 0800 952 3000
Website: www.victimadviceline.org.uk
Email: info@victimadviceline.org.uk

Opening Hours:
8am - 8pm Monday - Friday
9am - 5pm Saturdays

Save the Date – Dementia Education Event 

May 14th
Venue: The Bank House Hotel, Bransford, Worcester, WR6 5JD

Practice Dementia Leads are invited to a Living Well with Dementia joint event across Herefordshire and Worcestershire. This will include a session from Alistair Burns, National Clinical Lead for Dementia, Patient Stories and the Joint Dementia Strategy.

To secure your place, please book via Eventbrite.